COMPLIANCE INFO_2025 - Laserfiche WebLink

Home Browse Search

Please print or typo UNIFORM R WASTE HA`ARDOUS .I Generator ID Number g_Gener MANIFEST Form Approved.OMB No.2050 0039 '1lOr'S Name and 2.Page 1 0( 3,Emergency Response Phone 4.Manifest Tracking Number Mailing gddress ^7 r� q� /I 1 1 K v4p I. L 3 C'j �i aJ�J, RAIL L Generators Sile Address(if different than mailing address) C" 4 tyr - T 1Q31 Generators Phone: 6•Transporter 1rC� �fUli Company Name CA 95707 �.Transporter U.S.EPA ID Number 2 Company Name U.S-EPA ID Number 8.Designated F acility Name and Site Address U.S.EPA ID Number Faci lit y'sPhone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HIM and Packing Group(if any)) 13.Waste Codes O No. Type Quantity Wt.Nol. w LLJ 2. t� 3. 4. 14.Special Handling Instructions and Additional Information .•!-R l•rnt-� :lea ..+n.�.. V" .iti .- T T" ...,.n- ' ,,... @ 'i"3't.v 'ra`....__ , .ta. ft..to _ '�. .' _. 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 16.International Shipments El Import to U.S. Export from U.S. Port of entry/exit: iP— ? Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year O a z Transporter Printed/Typed Name Signature Month Day Year f- 18.Discrepancy 18a.Discrepancy Indication Space L1Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number i Facility's Phone: j 18r,Signature of Alternate Facility(or Generator) Month Day Ye 19 Hazardous Waste Report Management Method Codes(i.e„codes for hazardous waste treatment,disposal,and recycling systems) 11 2. 3. 4. 20.Designated facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a R"n YDed Name Signature Month Day